Endoscopic Sphincterotomy for Stones By Experts Is Safe, Even in Younger Patients With Normal Ducts

Abstract

ObjectiveTo provide current information on the risks of endoscopic sphincterotomy for stone. Summary Background DataIn recent years (since the popularity of laparoscopic cholecystectomy), endoscopic sphincterotomy has been used increasingly for the management of bile duct stones in relatively young and healthy patients. The validity of this trend has been questioned using data on short-term complications derived from earlier decades that involved more elderly and high-risk patients. MethodsSeven academic centers collected data prospectively using a common database. Complications within 30 days of the procedures were documented by standard criteria. ResultsOf 1921 patients, 1 12 (5.8%) developed complications; two thirds of these events were graded as mild (<3 days in hospital). There was no evidence of increased risk in younger patients or in those with smaller bile ducts. There was only one severe complication and there were no fatalities in 238 patients age <60, with bile duct diameters of <9 mm. ConclusionSphincterotomy for stones can be performed very safely by experienced endoscopists. 201

Endoscopic sphincterotomy with or without cholecystectomy for choledocholithiasis in high‐risk surgical patients: a decision analysis

“…[1][2][3] Endoscopic stone extraction is successful in over 96% of patients [3][4][5] with a low procedure-related morbidity (5.8%) and mortality (0.2%). 3 Subsequent laparoscopic cholecystectomy (LC) is the standard treatment in those patients with concomitant gall-bladder stones. The rationale for cholecystectomy is to prevent biliary complications such as acute cholecystitis, biliary colic, recurrent biliary stones, cholangitis and biliary pancreatitis.…”

Laparoscopic subtotal cholecystectomy for severe cholecystitis

“…Choledocholithiasis after LSC may be attributed to residual or newly formed stones in the remnant gallbladder or cystic duct. Since the endoscopic transpapillary approach has been established as a standard technique for common bile duct stones [30][31][32], it seems rational that safety of the surgery should be considered prior to thorough removal of gallstones in severe cholecystitis. Moreover, dissection or cannulation of the cystic duct for intraoperative cholangiography (IOC) should be avoided according to the concept of LSC.…”

Endoskopische Therapie der Choledocholithiasis

“…Endoskopische Papillotomie (EPT) Die endoskopische Spaltung der Papille ist eine risikoarme Methode, auch im jüngeren Lebensalter [8]. Frühkomplika-tionen treten in einer Häufigkeit von etwa 5-10% auf und betreffen in erster Linie Blutungen, retroperitoneale Perforationen und die Entwicklung von akuten Pankreatitiden und Cholangitiden [9,10].…”